Real-World Outcomes of Proprotein Convertase Subtilisin Kexin-9 Inhibitors Use.

While the proprotein convertase subtilisin kexin-9 inhibitors (PCSK9i) were shown to significantly lower LDL and reduce ASCVD events in clinical trials, there is a dearth of use data on these agents in real-world settings. This study compares PCSK9i use in a population of real-world patients with ASCVD or familial hypercholesterolemia. This was a matched, cohort study of adult patients who were dispensed a PCSK9i along with adult patients who did not receive a PCSK9i. PCSK9i patients were matched on a propensity to have received a PCSK9i score up to 1:10 to non-PCSK9i patients. The primary outcomes were changes in cholesterol levels. Secondary outcomes included a composite outcome of all-cause mortality, major cardiovascular events, and ischemic strokes along with healthcare utilization during follow-up. Adjusted conditional, multivariate Cox proportional hazards and negative binomial modeling were performed. Ninety-one PCSK9i patients were matched to 840 non-PCSK9i patients. 71% of PCSK9i patients either discontinued or switched PCSK9i therapy. PCSK9i patients had greater median reductions in LDL (-73.0 mg/dL vs. -30.0 mg/dL) and total (-77.0 vs. -31.0) cholesterol (both p<0.001). No adjusted, between-group differences in the composite outcome or individual components of the composite outcome were identified (all p>0.05). PCSK9i patients had a lower rate of medical office visits during follow-up (adjusted incidence rate ratio=0.61, p=0.019). These findings support the effectiveness of PCSK9i therapy in real-world settings but suggest that use may be limited by PCSK9i adverse reactions and patient cost-barriers.